Wednesday, April 30, 2014

Motivational Interviewing

Motivational Interviewing first emerged in Norway in 1982. It is a collaborative conversation style between a guide (helper) and someone desiring to make a positive change. Motivational Interviewing (MI) is designed to strengthen motivation for and commitment to a specific goal. The guide creates an atmosphere of acceptance and compassion while asking open-ended questions that elicit the person’s own reasons for making a behavior change. MI can be used as a stand-alone treatment; although when combined with other evidence — based treatments it enhances treatment outcomes.

The styles of communication used in MI has been found to produce positive results for people struggling with substance abuse and proved effectual with probationers in lowering recidivism rates, and with insubordinate employees in increasing cooperation with supervisors in the workplace. Many mental health facilities worldwide have added MI to their assessing and treatment planning protocol for behavior change with their clientele.

William Miller, Ph.D., further developed MI in the U.S. during the late 80’s while treating drug and alcohol dependent clients at an inpatient substance abuse treatment center. Miller’s colleagues complained clients were ‘difficult,’ ‘resistant,’ ‘in denial,’ and ‘out of touch with reality.’ When he was working with these clients, he did not experience the same problems. It made him question whether or not the complaints were a client problem or a counselor skill issue. He then set out on a quest to discover how to counsel in a way that evoked people’s own motivation for change rather than putting them on the defensive.

After years of researching specific communication styles that decreased resistance and increased successful outcomes, Miller along with Stephen Rollnick, Ph.D., published their findings, in the book Motivational Interviewing: Preparing People to Change Addictive Behavior.
Their findings showed when MI techniques were used there was a 51 percent decrease in alcohol use, substantially fewer relapses, and double many of the positive outcomes of 12-step, or Cognitive Behavioral Therapy treatments.

There are two main components to MI; relational and technical. Relational encompasses the interpersonal relationship between the guide and person desiring the change. The underlying perspective is each individual is the expert on him or herself, so the guide does not direct the person on what to do or how to proceed. The second component, technical is incorporated through the use of open-ended questions, which evoke internal strengths and resources.

Why, What, How, Tell Me

Most open-ended questions start with Why, What, How, and Tell me. Some examples are:
Why do you think you have a drinking problem?
What kind of a life do you have to create that would make you want to stay sober for it?
How do you want your life to be different?
Tell me what you don’t like about the way your life is now

Through working with thousands of clients, Miller and Rollnick discovered when people experience themselves as unacceptable they are immobilized and their ability to change is blocked. When on the other hand people experience being accepted as they are, they are free to change. They also found the more accurate empathy a counselor showed toward a client, the less they would relapse with drugs and alcohol. These discoveries led them to design four specific skills necessary for interviewers to use when working with people who verbalize wanting to make life changes.

Acceptance — prizing the inherent worth and potential of the person wanting to make the change
Accurate Empathy — actively being interested in understanding the person’s own perspective and frame of reference for desiring the change
Autonomy Support — allowing the person to choose their own way and determine what changes they want to make for their own life
Affirmation— acknowledging the person’s strengths and the efforts they have already made in working toward their goals for change

It is not uncommon for people to experience ambivalence when they are considering a change. They contemplate thoughts about making the change and wrestle with reasons to sustain their current behavior. When they verbalize this indecision it is important the interveiwer doesn’t try to persuade them one way or another, because this often calls forth resistance against the advice. When clients experienced resistance it prevents change. Instead, the interviewer can collaborate using the four key processes of MI:

Engaging — establishing a helpful connection and collaborative relationship with the client (A prerequisite for MI to be effective)
Focusing — developing and maintaining a specific direction in the conversation about the change the client wants to make.
Evoking — eliciting the clients own motivation for change, usually done with open-ended questions such as, “What do you think would be some advantages to making this change?”
Planning — formulating a concrete plan of action the client is motivated to follow, once they have committed to making the change

Miller and Rollnick discovered through reflective listening that commitment language predicted behavior change in people. Commitment language is when the person speaks of:
Their desire to change
Their belief that they have the ability to make the change
Their reasons and need for the change to occur
Their verbalization of goals and plans to acquire the change

It is possible to help people make positive changes in their lives— and Motivational Interviewing can help the process.
The rationale for change can come about for many reasons; some people feel forced to make changes due to outside circumstances beyond their control, while others desire changes because they want to better themselves or generate more positive outcomes in their life. Whatever the basis for change, using the MI approach can move people toward the transformation to which they aspire.
If you are interested in becoming trained in the MI approach visit http://www.motivationalinterviewing.org/ for training dates.

Elisabeth Davies, MC is the author of Good Things Emotional Healing Journal: Addiction